REGENXBIO Inc. (NASDAQ:RGNX) today provided an update on its investigational gene therapy, RGX-121 (clemidsogene lanparvovec), for the treatment of Mucopolysaccharidosis type II (MPS II), also known as Hunter Syndrome. The U.S. Food and Drug Administration (FDA) placed a clinical hold on RGX-121 following the discovery of asymptomatic spine MRI findings in five participants in the CAMPSIITE® study; REGENXBIO does not expect to resubmit the RGX-121 Biologics License Application (BLA) in the near term.

"We believe these findings are unique and limited to our Hunter Syndrome program, and require longer-term follow-up and additional data analysis to assess the benefit-risk profile of RGX-121," said Curran Simpson, President and CEO of REGENXBIO. "We remain focused on our Duchenne and retinal disease candidates, which utilize a different capsid and routes of administration, with near-term catalysts that are on track, including the planned submission of the Duchenne BLA this quarter and the wet AMD topline pivotal data announcement in the fourth quarter." 

All five participants continue to do well clinically and have demonstrated overall stability to improvement on neurocognitive and neurobehavioral assessments. The findings were identified through an expanded MRI monitoring plan, implemented by REGENXBIO a few months ago, following the clinical hold related to RGX-111. The enhanced monitoring included both brain and spine MRI and identified asymptomatic findings of either a small nodule or a small cystic mass in spine MRIs of five participants who received intracisternal or intraventricular RGX-121 approximately three to six years ago. Investigators deemed these findings to be nonserious and radiologists believe they are likely benign. There is no clinical or pathological evidence to confirm the nature or causation of the spine MRI findings. No brain nodules or masses were identified on any brain MRIs. 

Because spine MRI is not normally conducted for MPS in clinical practice or trials, the underlying prevalence and clinical significance of these types of asymptomatic findings in this patient population is unknown. Investigators plan to continue to observe these patients with periodic imaging only.

"Boys with neuronopathic MPS II experience a multitude of neurodevelopmental and systemic effects. While imaging natural history is limited for this ultra-rare disease, I believe that asymptomatic, likely benign findings like these may be inherent to the impact of Hunter Syndrome throughout the body," said Roberto Giugliani, M.D., Ph.D., Professor, Department of Genetics, UFRGS, Medical Genetics Service, HCPA, Porto Alegre, Brazil. "I am pleased that these patients are doing well and remain asymptomatic."

The Company and its partner NS Pharma are evaluating additional patient imaging and longer term follow up data, and will incorporate FDA feedback, including the full clinical hold letter once received, into next steps for RGX-121.